Provider Demographics
NPI:1295722486
Name:MYLOTTE, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MYLOTTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1465
Mailing Address - Country:US
Mailing Address - Phone:716-651-0911
Mailing Address - Fax:716-651-9855
Practice Address - Street 1:7264 NASH RD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1508
Practice Address - Country:US
Practice Address - Phone:716-694-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125943207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2208900OtherIHA
NY151122BJOtherPREFERRED CARE
NY01043461Medicaid
NY040511000519OtherFIDELIS
NY00010124505OtherUNIVERA
NY000508674005OtherBC/BS
NY2208900OtherIHA
NY000508674005OtherBC/BS
NY040511000519OtherFIDELIS
P00352575Medicare PIN